Bmv 2159 - Cdl Self Certification Authorization
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2OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
CDL SELF-CERTIFICATION AUTHORIZATION
New federal regulations require ALL Commercial Driver License (CDL) holders to self-certify their type of commercial
driving. All CDL holders must submit a self-certification in order to be issued and maintain their CDL.
NAME OF DRIVER
OHIO DRIVER LICENSE NUMBER
Please mark only one of the following self-certification categories that apply to you. (see page 2 for category detail)
I certify my commercial driving is:
Category 1: Non-Excepted Interstate: CDL holders who drive across state lines or transport freight that has or will
cross state lines and must meet federal medical requirements subject to 49 CFR part 391. Must submit a
medical card to the Ohio Bureau of Motor Vehicles (BMV).
Category 2: Excepted Interstate: CDL holders who drive across state lines but do not need to meet federal
medical requirements. Operating exclusively in transportation or operations excepted under 49 CFR 390.3(f),
391.2, 39168 or 398.3
Category 3: Non-Excepted Intrastate: CDL holders who drive exclusively in Ohio and do not drive across state
lines, but are required to meet state medical requirements.
Category 4: Excepted Intrastate: CDL holders who do not use the CDL for business purposes and are not
required to meet state medical requirements. Operating exclusively in transportation or operations excepted from
all or part of the State driver qualification requirements. (R.C. 4506.03(B)(1-10))
SIGNATURE OF APPLICANT
DATE
X
If you mark category 1, you must also submit a copy of your completed Medical Examiners Certificate.
I have included a Medical Examiners Certificate.
The CDL Self-Certification Authorization form and the Medical Examiners Certificate, if applicable, must be submitted to
the Ohio Bureau of Motor Vehicles and processed prior to the issuance of the CDL. The Self-Certification Authorization
form and the Medical Examiners Certificate can be submitted by mail, fax, e-mail, Regional Reinstatement Office or a
Deputy Registrar. The forms must be legible or a delay in processing will occur.
Mail the forms to:
Fax the forms to:
Submit the forms in person to:
Ohio BMV
(614) 308-5181 OR
A Regional Reinstatement Office OR a
CDL / In-State Violations Unit
e-mail to: cdl@dps.ohio.gov
Deputy Registrar. Locations can be
P.O. Box 16784
Include your name, address and
found by visiting
Columbus, OH 43216-6784
contact number on all faxes and
Include your name, address and
e-mails.
contact number on all mailings
RESTRICTED
BMV 2159 9/14 [760-1498] Page 1 of 2
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